Robotic surgery system with optical tracking

ABSTRACT

A robotic surgery system includes a mobile base, a robotic device mounted on the mobile base, a surgical tool positioned at a distal end of the robotic device, an optical tracking emitter/detector mounted on the mobile base and configured to track an anatomical feature, and circuitry configured to characterize a pose of the surgical tool relative to the anatomical feature based on data from the optical tracking emitter/detector.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.16/025,374, filed Jul. 2, 2018, which is a continuation of U.S. patentapplication Ser. No. 14/145,719 filed Dec. 31, 2013, which claims thebenefit of and priority to U.S. Provisional Patent Application No.61/747,854, filed Dec. 31, 2012, each of which is incorporated byreference herein in its entirety.

BACKGROUND

The present invention relates generally to robotic surgery techniques,and more particularly to configurations which may be utilized toefficiently facilitate intraoperative imaging by fluoroscopy duringsurgical procedures such as joint resurfacing or replacement.

With continued surgery-related diagnostic and treatment specialization,and increases in the costs associated with maintaining and staffingoperating room space, there is a continued need for capital equipmenttechnologies and configurations that facilitate flexibility andefficiency. For example, radiography and fluoroscopy systems forproviding intraoperative images during procedures such as orthopedicsurgery conventionally have included relatively large and unwieldlyhardware configurations, such as the conventional fluoroscopy C-armsystem 2 depicted in FIG. 1A, generally including a source 6 and adetector 8 fixedly coupled by a C-arm connecting structure 4, and theconventional flat-panel radiography system 10 depicted in FIG. 1B whichis partially ceiling-mounted and partially floor mounted. Operation ofthese systems generally requires moving one or more moveable portionsinto a position and/or orientation relative to one or more subjecttissue structures of a patient, and often repositioning and/orreorienting to capture additional images from another viewpoint relativeto the tissue structures. For example, in the case of many jointarthroplasty related procedures, it will be of interest for the surgeonto gather both antero/posterior and lateral views of the particularskeletal joint of interest, and gathering both views will requiremovements, either manually or electromechanically induced, of thevarious portions of imaging hardware. Further, it is sometimes the casethat the anatomy of interest of the patient will move during theprocedure, potentially requiring re-alignment of the imaging hardware toprocure additional intraoperative views. In addition, with the onset ofrobotic interventional systems and tools, such as system 12 depicted inFIG. 2 and sold under the tradename RIO® by MAKO Surgical Corporation ofFort Lauderdale, Fla. (including a mobile base 14 and an instrument 18,such as a bone cutting instrument, coupled to the mobile base 14 by anarticulated robotic arm 16), workflow can be interrupted by trading aninterventional system and an imaging system in and out of the space mostadjacent the patient tissue structures of interest during the procedure,which may require re-registration of the interventional and/or imagingsystems each time relative to the patient anatomy.

SUMMARY

One embodiment is directed to a robotic surgery system having a mobilebase configured to be moveable into and out of an operating room when ina freewheeling mode, and fixed relative to the operating room when in abraked mode. The system further includes a first moveable supportstructure coupled between the mobile base and a first element of afluoroscopic imaging system. The first element includes one of a sourceelement and a detector element and a second element of the fluoroscopicimaging system includes the other of the source element and the detectorelement. The second element is configured to be repositionable relativeto a patient tissue structure disposed between the first and secondelements of the fluoroscopic imaging system. The system further includesa coupling member configured to fixedly couple the first element of thefluoroscopic imaging system to the second element and a surgicalinstrument configured for conducting a procedure on the patient tissuestructure. The system further includes a second moveable supportstructure coupled between the coupling member and the surgicalinstrument, wherein the second moveable support structure includes oneor more actuators which may be controlled to electromechanicallycharacterize movement of the surgical instrument relative to thecoupling member.

The first moveable support structure may include an electromechanically-controllable robotic arm. The robotic arm may include one or more jointsand one or more motors configured to controllably regulate motion at theone or more joints. The system further may include at least one sensorconfigured to monitor a position of at least a portion of theelectromechanically-controllable robotic arm. The at least one sensormay be selected from the group consisting of: an encoder, apotentiometer, an optical position tracker, and an electromagneticposition tracker. The system further may include a controller coupled tothe electromechanically- controllable robotic arm and at least onesensor, the controller configured to cause theelectromechanically-controllable robotic arm to move at least in part inresponse to one or more signals received from the at least one sensor.The first element may be the source element and the second element maybe the detector element. The first element may be the detector clementand the second element may be the source element. The source element maybe configured to produce a collimated beam having a cross- sectionalshape selected from the group consisting of: a circle, an ellipse, asquare, and a rectangle. The detector element may be a flat paneldetector. The flat panel detector may be an amorphous silicon paneldetector. The flat panel detector may be a CMOS fluoroscopy panel. Theflat panel detector may have an effective image area having a shapeselected from the group consisting of: a circle, an ellipse, a square,and a rectangle. The flat panel detector may have a rectangular CMOSactive fluoroscopy panel having dimensions of about 5 inches by about 6inches. The surgical instrument may include a bone cutting tool. Thebone cutting tool may include a motor. The bone cutting cool may includea bone cutting element selected from the group consisting of: a rotarycutting burr, an insertion/retraction motion reciprocal cutting saw, anda lateral reciprocal motion cutting saw. The coupling member may includea substantially rigid member shaped to form a recess between the firstand second elements of the fluoroscopic imaging system, the recessconfigured to accommodate placement of the patient tissue structurebetween the first and second elements. The coupling member may be aC-arm. The system further may include a coupler configured to at leasttransiently couple a portion of the coupling member to a portion of anoperating table configured to support the patient tissue structure. Thecoupler may be manually- activated. The coupler may beelectromechanically-activated. The second moveable support structure mayinclude an electromechanically-controllable robotic arm. The robotic armmay include one or more joints and one or more motors configured tocontrollably regulate motion at the one or mere joints. The systemfurther may include at least one sensor configured to monitor a positionof at least a portion of the electromechanically-controllable roboticarm. The at least one sensor may be at least one of an encoder, apotentiometer, an optical position tracker, and an electromagneticposition tracker. The system further may include a controller coupled tothe electromechanically-controllable robotic arm and at least onesensor, the controller configured to resist movement of theelectromechanically- controllable robotic arm based at least in partupon one or more signals received from the at least one sensor. Thesystem further may include a controller operatively coupled to the oneor more actuators of the second moveable support structure andconfigured to receive signals from a sensing system operatively coupledto the controller, the sensing system configured to detect positions ofone or more sensor elements coupled to the patient tissue structure. Thecontroller may be operatively coupled to the surgical instrument andconfigured to modify one or more degrees of freedom of movement of thesurgical instrument relative to the patient tissue structure in responseto the signals from the sensing system. The controller may be configuredto actively inhibit movement of the surgical instrument in one or moredirections in response to the signals from the sensing system. Thesensing system may be one of an optical sensing system, anelectromagnetic sensing system, and a joint rotation sensing system. Theone or more sensor elements may be one of a reflective marker, anelectromagnetic localization sensor, a strain gauge, rotation encoder,and a joint rotation potentiometer. The system further may includesensor elements coupled to the first moveable support structure, whereinthe controller is configured to detect motion of the first moveablesupport structure. The system further may include sensor elementscoupled to the second moveable support structure, wherein the controlleris configured to detect motion of the first moveable support structure.The system further may include a user interface configured to allow foran operator to select a desired geometric relationship between the firstand second elements relative to the patient tissue structure.

The invention is capable of other embodiments and of being practiced orbeing carried out in various ways. Alternative exemplary embodimentsrelate to other features and combinations of features as may begenerally recited in the claims.

BRIEF DESCRIPTION OF THE FIGURES

The invention will become more fully understood from the followingdetailed description, taken in conjunction with the accompanyingdrawings, wherein like reference numerals refer to like elements, inwhich:

FIG. 1A depicts a conventional fluoroscopic imaging system with a C-armcoupling a source and a detector.

FIG. 1B depicts a conventional radiographic imaging system with a flatpanel detector.

FIG. 2 depicts a robotic surgery system with a mobile base.

FIG. 3A depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3B depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3C depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3D depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3E depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3F depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3G depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3H depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3I depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3J depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3K depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3L depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3M depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 3N depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 4A depicts portions of one embodiment of a robotic surgery systemwith integrated imaging capabilities, wherein a moveable instrumentsupport structure is configured to be temporarily positioned away fromone or more imaging elements during imaging.

FIG. 4B depicts portions of one embodiment of a robotic surgery systemwith integrated imaging capabilities, wherein an imaging element istemporarily re-positioned during a procedure with an instrument.

FIG. 5 illustrates one embodiment of a procedure for utilizing anembodiment of a robotic surgery system with integrated imagingcapabilities.

FIG. 6 illustrates one embodiment of a procedure for utilizing anembodiment of a robotic surgery system with integrated imagingcapabilities.

FIG. 7 illustrates one embodiment of a procedure for utilizing anembodiment of a robotic surgery system with integrated imagingcapabilities.

FIG. 8A depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 8B depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 8C depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 8D depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 8E depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 8F depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 8G depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 8H depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 9 illustrates one embodiment of a procedure for utilizing anembodiment of a robotic surgery system with integrated imagingcapabilities.

FIG. 10 illustrates one embodiment of a procedure for utilizing anembodiment of a robotic surgery system with integrated imagingcapabilities.

FIG. 11 illustrates one embodiment of a procedure for utilizing anembodiment of a robotic surgery system with integrated imagingcapabilities.

FIG. 12A depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 12B depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 12C depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 12D depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 12E depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 12F depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 12G depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 12H depicts one embodiment of a robotic surgery system withintegrated imaging capabilities.

FIG. 13 illustrates one embodiment of a procedure for utilizing anembodiment of a robotic surgery system with integrated imagingcapabilities.

FIG. 14 illustrates one embodiment of a procedure for utilizing anembodiment of a robotic surgery system with integrated imagingcapabilities.

FIG. 15 illustrates one embodiment of a procedure for utilizing anembodiment of a robotic surgery system with integrated imagingcapabilities.

DETAILED DESCRIPTION

Before turning to the figures, which illustrate the exemplaryembodiments in detail, it should be understood that the application isnot limited to the details or methodology set forth in the descriptionor illustrated in the figures. It should also be understood that theterminology is for the purpose of description only and should not beregarded as limiting.

Referring to FIGS. 3A-3N, various embodiments of systems for conductingrobotic surgical procedures are presented, wherein interventional toolssuch as bone cutting instruments may be operated from a common platformalso having integrated imaging capabilities to facilitate workflowoptimization. Referring to FIG. 3A, conventionally one of the challengesin robotically-assisted interventional procedures has been registeringsurgical instrumentation with images that may be generated using imagingsystems such as fluoroscopes, so that the instrumentation may benavigated around in a workspace relative to the imaged patient tissuestructure with a high level of precision. As described above, thistypically has required that a mobile imaging system and mobile roboticsurgery system be given alternate access to the most immediate workspacearound the targeted tissue structures - thus the workflow interruptionfor moving hardware, registering the coordinate systems of the variouspieces of hardware relative to each other and the subject anatomy, andconducting portions of the imaging or surgical procedure serially. Thesystem shown in FIG. 3A addresses this workflow challenge by integratingthe interventional/surgical system with imaging technologies.

According to the embodiments herein, a geometric/mathematicalrelationship is established between the coordinate systems of variouselements of the procedure, so that each of such elements may remainregistered to the others. For example, referring again to FIG. 3A, aglobal coordinate system 50 is associated with the floor 22, ceiling, orwalls of the operating room. Generally, the coordinate system 48 of theoperating table 20 relative to the global coordinate system 50 will beknown with an operating table fixedly attached to the floor 22 as shown.In one variation, the anatomy is temporarily immobilized relative to theoperating table using straps or other mechanical coupling members. Withthe relationship between the coordinate system 58 of the targetedanatomy 46 and the coordinate system 48 of the operating table 20 known,an integrated imaging-intervention system may be registered to theoperating table or anatomy, and with a knowledge of the position and/ororientation of various portions of such system, all associatedcoordinate systems and elements may be brought into inherentregistration with the anatomy. In this way, imaging and surgicalintervention, such as bone or other tissue cutting, may be accomplishedwith precision, along with simultaneous imaging. In one embodiment, aknowledge of the positions of one or more wheels 62 of a mobile basesubsystem 24, along with the dimensions of such subsystem, is utilizedto establish a transformation between the global coordinate system 50and the coordinate system 52 for the mobile base 24. A first moveablesupport structure 26 includes a first member 28 movably coupled to asecond member 30. The moveable support structure 26 is utilized tosupport and couple the mobile base 24 to a coupling member 32 configuredto support two opposing imaging elements 34, 36 of a fluoroscopy system(i.e., wherein one element includes a source element and another elementincludes a detector element) in a known configuration relative to eachother. In a preferred embodiment, whichever element is the detectorelement includes a flat panel detector. The flat panel detector may bean amorphous silicon panel detector. The flat panel detector may be aCMOS fluoroscopy panel. The flat panel detector may have an effectiveimage area having a particular shape such as a circle, an ellipse, asquare, or a rectangle. In one embodiment, a rectangular CMOS activefluoroscopy panel has dimensions of about 5 inches by about 6 inches. Ina preferred embodiment, the corresponding source element includes anX-ray source. The source element may be configured to produce acollimated beam having a cross-sectional shape, such as a circle, anellipse, a square, or a rectangle.

As shown in FIG. 3A, the coupling member 32 is also coupled to andconfigured to support a second moveable support structure 40 having afirst member 42 movably coupled to a second member 44. The second member44 is movably coupled to an instrument 38, such as a bone-cuttinginstrument. It is desirable to maintain a registration between all ofthe involved elements, and in particular the coordinate systems of theelements, including the coordinate system 58 of the targeted anatomy 46,the coordinate system 56 of the instrument 38, and the coordinate system54 of imaging elements/coupling member 32 so that image-basedintervention may be conducted.

One way of monitoring the relative positioning/orientation of variouselements is to monitor and/or understand the positions of the variousjoints or moveable couplings 60 between the physical elements. Forexample, the first and the second moveable support structures mayinclude joint rotation encoders and/or actuators at the moveable jointsthat may be read and/or controlled by a controller toelectromechanically characterize movement of the elements of the systemrelative to each other. Alternatively, or in addition, the positionsand/or orientations of the physical elements themselves may bemonitored. FIGS. 3B-3F illustrate various embodiments wherein jointpositions and/or physical element positions and/or orientations of anintegrated imaging/intervention system are monitored, given aconfiguration wherein the targeted anatomy 46 is in a known fixedconfiguration relative to the coordinate systems of the operating table48 and/or the operating room floor 50.

Referring to FIG. 3B, in one embodiment, moveable joints are fitted withjoint encoders 64. The joint encoders 64 may be fitted to the moveablejoints of one or more wheels 62 of the mobile base 24, to the moveablejoints of the first moveable support structure 26, and to the moveablejoints of the second moveable support structure 40. Each of theseencoders 64 is operatively coupled (i.e., via wireless link or wiredlead, not shown) back to a controller 66, such as a computer, which iscoupled to the mobile base 24 as shown. Using the known geometricdimensions of the various physical elements, the encoder readings, andcoordinate transformation techniques, the position and orientation ofthe instrument 38 relative to the anatomy 46, as well as the positionand orientation of the imaging elements 34, 36 relative to the anatomy,may be determined in real or near-real time. The wheels 62 areconfigured to be manually or electromechanically lockable or braked tomaintain position and orientation of the mobile base 24 relative to thefloor 22.

Referring to FIG. 3C, an optical tracking system 68, along with aplurality of reflector arrays or sensors 70 fixedly or removably coupledto pertinent structures as shown, are also utilized to register suchstructures to the coordinate system 58 of the anatomy 46 if therelationship between the tracking system source/detector 68 and targetedanatomy 46 is established.

Referring to FIG. 3D, an electromagnetic tracking system 76, along witha plurality of electromagnetic sensors 78 fixedly or removably coupledto pertinent structures as shown (such sensors generally will beoperatively coupled, via a system of wire leads (not shown) back to thesource/detector 76 and/or back to a central controller 66. Thesource/detector 76 preferably also is operatively coupled to thecontroller 66, as shown with the depicted wire lead 74. Thesource/detector 76 is also utilized to register such structures to thecoordinate system 58 of the anatomy 46 if the relationship between thetracking system source/detector 76 and targeted anatomy 46 isestablished.

Referring to FIG. 3E, a mechanical tracker subsystem 86 has one or morerelatively stiff members 82, 84 intercoupled by encoded joints 64 isutilized to characterize the position and/or orientation of variouselements of the system, such as the coupling member 32 as shown,relative to the floor 22 to which the mechanical tracker 86 is groundedor coupled. Encoded joints 64 for the second moveable support structure40 are utilized to characterize the relationship between the couplingmember 32 and the surgical instrument 38.

Referring to FIG. 3F, for illustrative purposes, it is shown that insome embodiments multiple tracking/characterization modalities (hereencoded joints 64, optical tracking 68/70, electromechanical tracking76/78, and mechanical tracking 64/86) are combined to understand thepositioning and orientation of a surgical instrument 38, targetedanatomy 46, and imaging elements 34, 36 relative to each other.

Referring to FIGS. 3G-3J, such tracking configurations may further beemployed to monitor the position and/or orientation of the anatomyrelative to other elements and coordinate systems. For example,referring to FIG. 3G, a combination of joint encoders 64 and opticaltracking 68/70 are utilized to characterize the positioning and/ororientation of the anatomy 46, surgical instrument 38, and imagingelements 34, 36.

Referring to FIG. 3H, a combination of joint encoders 64 andelectromagnetic tracking 76/78 are utilized to characterize thepositioning and/or orientation of the anatomy 46, surgical instrument38, and imaging elements 34, 36.

Referring to FIG. 3I, there is shown a combination of joint encoders 64on portions of the system elements, along with a mechanical tracker 94having additional joint encoders 64 coupled directly to the anatomy 46on one end and coupled to the operating table 20 at the other end. Thiscombination also may be utilized to characterize the positioning and/ororientation of the anatomy 46, surgical instrument 38, and imagingelements 34, 36.

Referring to FIG. 3J, a combination of joint encoders 64,electromagnetic tracking 76/78, mechanical tracking 86/64, and opticaltracking 68/70 are utilized to characterize the positioning and/ororientation of the anatomy 46, surgical instrument 38, and imagingelements 34, 36.

Referring to FIG. 3K, a combination of joint encoders 64 and opticaltracking (utilizing emitter/detector 96 and reflector array 70) areutilized to characterize the positioning and/or orientation of theanatomy 46, surgical instrumentation 38, and imaging elements 34, 36,here with the optical tracker emitter/detector 96 directly coupled toone element (such as coupling member 32) of the integrated system. Inthe depicted embodiment, the emitter/detector 96 is movably controlledby a user interface to move as depicted by arrow 98. Preferably, theemitter/detector 96 is electromechanically moveable using an actuatorcontrolled by a user interface.

Referring to FIG. 3L, a combination of joint encoders 64 andelectromagnetic tracking 76/78) are utilized to characterize thepositioning and/or orientation of the anatomy 46, surgicalinstrumentation 38, and imaging elements 34, 36. In the embodimentshown, the electromagnetic transmitter 76 is mounted upon the couplingmember 32, or may be mounted to another structure of the integratedsystem.

Referring to FIG. 3M, a combination of joint encoders 64 coupled to thesystem elements and an encoded mechanical tracker (having arms 88, 90,92 and joint encoders 64) are utilized to characterize the positioningand/or orientation of the anatomy 46, surgical instrumentation 38, andimaging elements 34, 36. In the embodiment shown, the mechanical tracker(having arms 88, 90, and 92 and encoders 64) is coupled to the couplingmember 32 or other structure of the integrated system. Also shown inthis embodiment is a lockable linkage having one or more substantiallyrigid elongate members 104, 106 and one or more releasably lockablejoints 108. The lockable linkage is configured to temporarily fix andstructurally couple the operating table 20 and the coupling member 32,to serve as a stress/load relief for the integrated system, and tominimize micromotion that may occur from deflection/strain of componentsunder relatively large cantilevered loads.

For illustrative purposes, a multi-modality configuration is shown inFIG. 3N, with encoded joints 64 coupled to the system elements, amechanical tracker 86 having encoded joints 64, electromagneticsensing/tracking 76/78, optical sensing/tracking 68/70, and opticaltracking utilizing an emitter/detector 96 coupled to an element of thesystem and reflector array 70 combined to characterize the positioningand/or orientation of the anatomy 46, surgical instrumentation 38, andimaging elements 34, 36.

Referring to FIGS. 4A-4B, the second moveable support structure 40 isconfigured to automatically move, or be moveable, such that the surgicalinstrument 38 is mobilized out of the way of the imaging element ortracking hardware 96. The imaging element 96 may then be moved, asdepicted by arrow 112, into a position nearby. Upon completion of adiscrete imaging or tracking exercise or acquisition, the imagingelement or tracking hardware 96 may be moved back, as depicted by arrow114, into an away position to accommodate more movement workspace forthe second moveable support structure 40 and instrument 38.

Referring to FIGS. 5-7, techniques for utilizing systems such as thosedepicted in FIGS. 3A-4B are illustrated.

Referring to FIG. 5, after preoperative patient preparation anddiagnostics (step 116), the targeted tissue structure, such as a bone orjoint of an appendage, is temporarily immobilized relative to theoperating table (step 118). A mobile base of an integratedimaging/intervention system is advanced into place and locked intoposition relative to the operating room floor using locking wheels (step120). An imaging element coupling member is moved into place relative tothe targeted tissue structure by moving first moveable support structurewhich couples the coupling member to the mobile base (step 122). Asurgical instrument is then moved into place to have a workspacesuitable for the intervention on the tissue structure using first andsecond moveable support structures coupled by a coupling member, and thesurgical instrument is registered to a known coordinate system (step124). Intervention is conducted while also allowing for simultaneousimaging using the inherently registered imaging components (step 126),after which the procedure is completed and tissue access closed (step128).

Referring to FIG. 6, an embodiment similar to that of FIG. 5 isillustrated, with the exception that at least one tracking sensor (forexample, an encoded mechanical tracker, an electromagnetic sensor, anoptical sensor, etc.) is coupled directly to the targeted tissuestructure (step 130), for example, as described above in reference toFIGS. 3G-3J, to characterize the position and/or orientation of thetissue relative to another known coordinate system. In this exemplarytechnique, after preoperative patient preparation and diagnostics (step116), a tracking sensor is coupled to the targeted tissue structure(step 130). The tracking sensor is configured to provide position and/ororientation date relative to the operative table and/or globalcoordinate system. A mobile base of an integrated imaging/interventionsystem is advanced into place and locked into position relative to theoperating room floor using locking wheels (step 120). An imaging elementcoupling member is moved into place relative to the targeted tissuestructure by moving first moveable support structure which couples thecoupling member to the mobile base (step 122). A surgical instrument isthen moved into place to have a workspace suitable for the interventionon the tissue structure using first and second moveable supportstructures coupled by a coupling member, and the surgical instrument isregistered to a known coordinate system (step 124). Intervention isconducted while also allowing for simultaneous imaging using theinherently registered imaging components (step 126), after which theprocedure is completed and tissue access closed (step 128).

Referring to FIG. 7, an embodiment similar to that of FIG. 5 isillustrated, with the exception that at least one tracking sensor (forexample, an encoded mechanical tracker, an electromagnetic sensor, anoptical sensor, etc.) is intercoupled between the targeted tissuestructure and a portion of the integrated intervention/imaging hardwareitself (step 132), for example, as described above in reference to FIGS.3K-3N, to characterize the position and/or orientation of the tissuerelative to another known coordinate system. In this exemplarytechnique, after preoperative patient preparation and diagnostics (step116), a tracking sensor is coupled to the targeted tissue structure(step 132). The tracking sensor is configured to provide position and/ororientation date relative to an imaging element coupling memberinterposed between first and second imaging elements, and coupled to amobile base. A mobile base of an integrated imaging/intervention systemis advanced into place and locked into position relative to theoperating room floor using locking wheels (step 120). An imaging elementcoupling member is moved into place relative to the targeted tissuestructure by moving first moveable support structure which couples thecoupling member to the mobile base (step 122). A surgical instrument isthen moved into place to have a workspace suitable for the interventionon the tissue structure using first and second moveable supportstructures coupled by a coupling member, and the surgical instrument isregistered to a known coordinate system (step 124). Intervention isconducted while also allowing for simultaneous imaging using theinherently registered imaging components (step 126), after which theprocedure is completed and tissue access closed (step 128).

Referring to FIGS. 8A-11, another group of embodiments is depictedwherein a three-armed configuration may be utilized for integratedimaging/intervention, with some similarity to the imaging, sensing,registration paradigms discussed above in reference to FIGS. 3A-7.Referring to FIG. 8A, a mobile base 24 including a controller (notshown; similar to controller 66 shown in FIGS. 3B-3N) and lockablewheels 62 function as a central mechanical hub for three arms, as wellas for a display 134 and display support 142. Various sensing, monitor,and mechanical configurations may be utilized, with an objective ofhaving various coordinate systems and components registered so thatimaging and interventional steps may be conducted with an efficientworkflow, along with inherent registration given available sensing andgeometric dimensions. The configuration of FIG. 8A features two imagingelements opposed from each other with the targeted tissue structure 46in between, mounted upon or coupled to an operating table 20 that ismounted to or coupled to the floor 22 of the operating room. One imagingelement 36 (either a source or a detector) is coupled to a lower roboticarm having two elongate segments 160, 162, while the other element 34(the other of either a source or a detector) is coupled to a right upperrobotic arm having two elongate segments 148, 150 coupled by joints 60.A one or more degree-of-freedom wrist 158 (not visible) may provideadditional freedom of motion between the imaging element 34 and the endof the most distal right upper robotic arm segment 150. In thisembodiment, a left upper robotic arm also has two segments 152, 154joined by joints 60 is utilized to move/navigate a surgical instrument38 using a wrist component 156 which may have multiple degrees offreedom, such as yaw, pitch, and roll. Both upper arms in the depictedconfiguration are coupled to a first common arm member 146, which ismovably coupled to a second common arm member 144, which is movablycoupled to the mobile base 24. As described below, the coordinatesystems of the various components, such as the coordinate systems of thefirst common arm member (coordinate system 136), first imaging element(coordinate system 138), second imaging element (coordinate system 140),targeted tissue structure (coordinate system 58), surgical instrument(coordinate system 56), mobile base (coordinate system 52), andoperating room (coordinate system 50) may all be kept in registrationwith appropriate monitoring of positions and/or orientations of thevarious components given certain variables such as geometric dimensions.

Referring to FIG. 8B, encoded joints 64 are utilized to maintainregistration between the various components of the system relative toeach other. Given a relationship to a coordinate system 58 of thetargeted tissue structure 46 (which may be temporarily fixed relative tothe operating table 20), the surgical instrumentation 38, anatomy 46,and imaging elements 34, 36 may be kept in registration for theprocedure.

Referring to FIG. 8C, optical tracking sensors 70 and an opticaltracking emitter/detector 68 and a plurality of reflector arrays orsensors 70 fixedly or removably coupled to pertinent structures areutilized to monitor the positions and/or orientations of the variouscomponents, as opposed to encoded joints as in the embodiment of FIG.8B.

Referring to FIG. 8D, electromagnetic tracking sensors 78 and an opticaltracking emitter/system 76 are utilized to monitor the positions and/ororientations of the various components, as opposed to encoded joints asin the embodiment of FIG. 8B.

Referring to FIG. 8E, a combination of encoded joints 64 and mechanicaltrackers 83/85/87, 82/84/86 having encoded joints 64 are utilized tomonitor the positions and/or orientations of the various components.

Referring to FIG. 8F, a system combining multiple monitoring modalities,such as optical tracking 68/70, electromagnetic tracking 76/78, encodedjoints 64, and additional mechanical trackers 83/85/87, 82/84/86 withencoded joints 64 are utilized to monitor the positions and/ororientations of the various components.

FIGS. 8G and 8H feature embodiments similar to that of FIG. 8F, with theexception that tracking configurations are also utilized to track theanatomy itself. FIG. 8G depicts optical tracking 68/70 with theemitter/detector 68 external to the operational system hardware. FIG. 8Hdepicts the emitter detector 69 integral with the system, i.e., having aportion of the hardware, such as imaging element 34 as shown, mountedupon one of the arms. An external emitter/detector 68 is also shown, andmay also be utilized in parallel.

Referring to FIGS. 9-11, techniques for utilizing systems such as thosedepicted in FIGS. 8A-8H are illustrated.

Referring to FIG. 9, after preoperative patient preparation anddiagnostics (step 116), in one embodiment the targeted tissue structure,such as a bone or joint of an appendage, is temporarily immobilizedrelative to the operating table (step 118). A mobile base of anintegrated imaging/intervention system is advanced into place and lockedinto position relative to the operating room floor using locking wheels(step 120). An imaging element coupling member is moved into placerelative to the targeted tissue structure by moving moveable supportassemblies which couple the first and second imaging elements andsurgical instrument to the mobile base (step 164). A surgical instrumentis then moved into place to have a workspace suitable for theintervention on the tissue structure using the moveable supportstructure coupled to the base, and the surgical instrument is registeredto a known coordinate system (step 166). Intervention is conducted whilealso allowing for simultaneous imaging using the inherently registeredimaging components (step 168), after which the procedure is completedand tissue access closed (step 170).

Referring to FIG. 10, an embodiment similar to that of FIG. 9 isillustrated, with the exception that at least one tracking sensor (forexample, an encoded mechanical tracker, an electromagnetic sensor, anoptical sensor, etc.) is coupled directly to the targeted tissuestructure (step 130), for example, as described above in reference toFIG. 8G, to characterize the position and/or orientation of the tissuerelative to another known coordinate system. In this exemplarytechnique, after preoperative patient preparation and diagnostics (step116), a tracking sensor is coupled to the targeted tissue structure(step 130). The tracking sensor is configured to provide position and/ororientation date relative to the operative table and/or globalcoordinate system. A mobile base of an integrated imaging/interventionsystem is advanced into place and locked into position relative to theoperating room floor using locking wheels (step 120). An imaging elementcoupling member is moved into place relative to the targeted tissuestructure by moving moveable support assemblies which couple the firstand second imaging elements and surgical instrument to the mobile base(step 164). A surgical instrument is then moved into place to have aworkspace suitable for the intervention on the tissue structure usingthe moveable support structure coupled to the base, and the surgicalinstrument is registered to a known coordinate system (step 166).Intervention is conducted while also allowing for simultaneous imagingusing the inherently registered imaging components (step 168), afterwhich the procedure is completed and tissue access closed (step 170).

Referring to FIG. 11, an embodiment similar to that of FIG. 9 isillustrated, with the exception that at least one tracking sensor (forexample, an encoded mechanical tracker, an electromagnetic sensor, anoptical sensor, etc.) is intercoupled between the targeted tissuestructure and a portion of the integrated intervention/imaging hardwareitself (step 132), for example, as described above in reference to FIG.8H, to characterize the position and/or orientation of the tissuerelative to another known coordinate system. In this exemplaryembodiment, after preoperative patient preparation and diagnostics (step116), a tracking sensor is coupled to the targeted tissue structure(step 132). The tracking sensor is configured to provide position and/ororientation date relative to an imaging element coupling memberinterposed between first and second imaging elements, and coupled to amobile base. A mobile base of an integrated imaging/intervention systemis advanced into place and locked into position relative to theoperating room floor using locking wheels (step 120). An imaging elementcoupling member is moved into place relative to the targeted tissuestructure by moving moveable support assemblies which couple the firstand second imaging elements and surgical instrument to the mobile base(step 164). A surgical instrument is then moved into place to have aworkspace suitable for the intervention on the tissue structure usingthe moveable support structure coupled to the base, and the surgicalinstrument is registered to a known coordinate system (step 166).Intervention is conducted while also allowing for simultaneous imagingusing the inherently registered imaging components (step 168), afterwhich the procedure is completed and tissue access closed (step 170).

Referring to FIGS. 12A-15, another group of embodiments is depictedwherein a operating table-based configuration may be utilized forintegrated imaging/intervention, with some similarity to the imaging,sensing, registration paradigms discussed above in reference to FIGS.3A-7. Referring to FIG. 12A, the operating table 172 is optionallytemporarily or permanently fixedly coupled to the floor 22. The table172 is fixed particularly in embodiments wherein a coordinate system ofan external element, such as an optical tracking emitter/detector, isutilized, and thus movement of that coordinate system relative to thetable is of additional importance. The table 172 functions as a centralmechanical hub for an imaging arm structure having elements 28, 30, 33,an anatomy support structure 184, and an instrument support structure180 mounted or coupled to the anatomy support structure 184. Varioussensing, monitor, and mechanical configurations may be utilized, with anobjective of having various coordinate systems and components registeredso that imaging and interventional steps may be conducted with anefficient workflow, along with inherent registration given availablesensing and geometric dimensions. The configuration of FIG. 12A featurestwo imaging elements 34, 36 opposed from each other with the targetedtissue structure 46 in between, mounted upon or coupled to the operatingtable 172 by virtue of the anatomy support structure 184. One imagingelement 36 (either a source or a detector) is coupled to a lower portionof the coupling member 33 while the other element 34 (the other ofeither a source or a detector) is coupled to an upper aspect of thecoupling member 33. moveable joints 60 preferably are utilized to couplemore rigid components in positions of desired freedom of motion, as inthe embodiments described above. An auxiliary stabilization structure orarm 176 featuring a stabilization interface member 178 may also bemovably coupled to the operating table 172. As described below, thecoordinate systems of the various components, such as the coordinatesystems of the first imaging element (coordinate system 138), secondimaging element (coordinate system 140), targeted tissue structure(coordinate system 58), surgical instrument (coordinate system 56),operating table (coordinate system 48), and operating room (coordinatesystem 50) may all be kept in registration with appropriate monitoringof positions and/or orientations of the various components given certainvariables such as geometric dimensions.

Referring to FIG. 12B, encoded joints 64 are utilized to maintainregistration between the various components of the system relative toeach other. Given a relationship to a coordinate system 58 of thetargeted tissue structure 46 (which may be temporarily fixed relative tothe operating table 172), the surgical instrumentation 38, anatomy 46,and imaging elements 34, 36 may be kept in registration for theprocedure.

Referring to FIG. 12C, optical tracking sensors 70 and an opticaltracking emitter/detector 68 are utilized to monitor the positionsand/or orientations of the various components, as opposed to encodedjoints as in the embodiment of FIG. 12B.

Referring to FIG. 12D, electromagnetic tracking sensors 78 and anoptical tracking emitter/system 76 are utilized to monitor the positionsand/or orientations of the various components, as opposed to encodedjoints as in the embodiment of FIG. 12B.

Referring to FIG. 12E, a combination of encoded joints 64 and mechanicaltracker 83/85/87 having encoded joints 64 are utilized to monitor thepositions and/or orientations of the various components.

Referring to FIG. 12F, a system combining multiple monitoringmodalities, such as optical tracking 68/70, electromagnetic tracking76/78, encoded joints 64, and additional mechanical tracker 83/85/87with encoded joints 64 are utilized to monitor the positions and/ororientations of the various components.

FIGS. 12G and 12H feature embodiments similar to that of FIG. 12F, withthe exception that tracking configurations are also utilized to trackthe anatomy itself. FIG. 12G shows optical tracking 68/70 with theemitter/detector 68 external to the operational system hardware. FIG.12H shows the emitter detector 96 integral with the system, i.e., havinga portion of the hardware mounted upon one of the arms. An externalemitter/detector 68 is also shown and may also be utilized in parallel.

Referring to FIGS. 13-15, techniques for utilizing systems such as thosedepicted in FIGS. 12A-12H are illustrated.

Referring to FIG. 13, after preoperative patient preparation anddiagnostics (step 116), in one embodiment the targeted tissue structure,such as a bone or joint of an appendage, is temporarily coupled relativeto the operating table in a known position/orientation (step 188). Animaging element coupling member is moved into place by moving theassociated support assembly (step 190). The surgical instrument isregistered to a known coordinate system (step 192) and the interventionconducted while also allowing for simultaneous imaging using theinherently registered imaging components (step 194), after which theprocedure is completed and tissue access closed (step 196).

Referring to FIG. 14, an embodiment similar to that of FIG. 13 isillustrated, with the exception that a tracking sensors (for example, anencoded mechanical tracker, an electromagnetic sensor, an opticalsensor, etc.) is coupled directly to the targeted tissue structure (step198), for example, as described above in reference to FIG. 12G, tocharacterize the position and/or orientation of the tissue relative toanother known coordinate system. In this exemplary technique, afterpreoperative patient preparation and diagnostics (step 116), a trackingsensor is coupled to the targeted tissue structure (step 198). Thetracking sensor is configured to provide position and/or orientationdate relative to the operative table and/or global coordinate system(step 198). An imaging element coupling member is moved into place bymoving the associated support assembly (step 190). The surgicalinstrument is registered to a known coordinate system (step 192) and theintervention conducted while also allowing for simultaneous imagingusing the inherently registered imaging components (step 194), afterwhich the procedure is completed and tissue access closed (step 196).

Referring to FIG. 15, an embodiment similar to that of FIG. 13 isillustrated, with the exception that a tracking sensors (for example, anencoded mechanical tracker, an electromagnetic sensor, an opticalsensor, etc.) is intercoupled between the targeted tissue structure anda portion of the integrated intervention/imaging hardware itself (step200), for example, as described above in reference to FIG. 12H, tocharacterize the position and/or orientation of the tissue relative toanother known coordinate system. In this exemplary embodiment, afterpreoperative patient preparation and diagnostics (step 116), a trackingsensor is coupled to the targeted tissue structure (step 200). Thetracking sensor is configured to provide position and/or orientationdata relative to an imaging element coupling member interposed betweenfirst and second imaging elements and coupled to an operating table. Animaging element coupling member is moved into place by moving theassociated support assembly (step 190). The surgical instrument isregistered to a known coordinate system (step 192) and the interventionconducted while also allowing for simultaneous imaging using theinherently registered imaging components (step 194), after which theprocedure is completed and tissue access closed (step 196).

The exemplary systems and methods described herein may be used andimplemented as part of a robotic surgery system, such as that describedin U.S. Pat. No. 8,010,180, entitled “Haptic Guidance System and Method”issued Aug. 30, 2011, which is hereby incorporated by reference in itsentirety.

Various exemplary embodiments of the invention are described herein.Reference is made to these examples in a non-limiting sense. They areprovided to illustrate more broadly applicable aspects of the invention.Various changes may be made to the invention described and equivalentsmay be substituted without departing from the true spirit and scope ofthe invention. In addition, many modifications may be made to adapt aparticular situation, material, composition of matter, process, processact(s) or step(s) to the objective(s), spirit or scope of the presentinvention. Further, as will be appreciated by those with skill in theart that each of the individual variations described and illustratedherein has discrete components and features which may be readilyseparated from or combined with the features of any of the other severalembodiments without departing from the scope or spirit of the presentinventions. All such modifications are intended to be within the scopeof claims associated with this disclosure.

Any of the devices described for carrying out the subject diagnostic orinterventional procedures may be provided in packaged combination foruse in executing such interventions. These supply “kits’ may furtherinclude instructions for use and be packaged in sterile trays orcontainers as commonly employed for such purposes.

The invention includes methods that may be performed using the subjectdevices. The methods may include the act of providing such a suitabledevice. Such provision may be performed by the end user. In other words,the “providing” act merely requires the end user obtain, access,approach, position, set-up, activate, power-up or otherwise act toprovide the requisite device in the subject method. Methods recitedherein may be carried out in any order of the recited events which islogically possible, as well as in the recited order of events.

Exemplary aspects of the invention, together with details regardingmaterial selection and manufacture have been set forth above. As forother details of the present invention, these may be appreciated inconnection with the above-referenced patents and publications as well asgenerally known or appreciated by those with skill in the art. The samemay hold true with respect to method-based aspects of the invention interms of additional acts as commonly or logically employed.

In addition, though the invention has been described in reference toseveral examples optionally incorporating various features, theinvention is not to be limited to that which is described or indicatedas contemplated with respect to each variation of the invention. Variouschanges may be made to the invention described and equivalents (whetherrecited herein or not included for the sake of some brevity) may besubstituted without departing from the true spirit and scope of theinvention. In addition, where a range of values is provided, it isunderstood that every intervening value, between the upper and lowerlimit of that range and any other stated or intervening value in thatstated range, is encompassed within the invention.

Also, it is contemplated that any optional feature of the inventivevariations described may be set forth and claimed independently, or incombination with any one or more of the features described herein.Reference to a singular item, includes the possibility that there areplural of the same items present. More specifically, as used herein andin claims associated hereto, the singular forms “a,” “an,” “said,” and“the” include plural referents unless the specifically stated otherwise.In other words, use of the articles allow for “at least one” of thesubject item in the description above as well as claims associated withthis disclosure. It is further noted that such claims may be drafted toexclude any optional element. As such, this statement is intended toserve as antecedent basis for use of such exclusive terminology as“solely,” “only” and the like in connection with the recitation of claimelements, or use of a “negative” limitation.

Without the use of such exclusive terminology, the term “comprising” inclaims associated with this disclosure shall allow for the inclusion ofany additional element—irrespective of whether a given number ofelements are enumerated in such claims, or the addition of a featurecould be regarded as transforming the nature of an element set forth insuch claims. Except as specifically defined herein, all technical andscientific terms used herein are to be given as broad a commonlyunderstood meaning as possible while maintaining claim validity.

The breadth of the present invention is not to be limited to theexamples provided and/or the subject specification, but rather only bythe scope of claim language associated with this disclosure.

What is claimed is:
 1. A robotic surgery system, comprising: a mobilebase; a robotic device mounted on the mobile base; a surgical toolpositioned at a distal end of the robotic device; an optical trackingemitter/detector mounted on the mobile base and configured to track ananatomical feature; and circuitry configured to characterize a pose ofthe surgical tool relative to the anatomical feature based on data fromthe optical tracking emitter/detector.
 2. The robotic surgery system ofclaim 1, wherein: the mobile base comprises wheels configured to allowmovement of the mobile base; and the movement of the mobile base causescorresponding motion of the robotic device, the surgical tool, and theoptical tracking emitter/detector.
 3. The robotic surgery system ofclaim 2, wherein the wheels are electronically lockable to prevent themovement of the mobile base.
 4. The robotic surgery system of claim 1,further comprising a display screen mounted on the mobile base.
 5. Therobotic surgery system of claim 4, further comprising: a first displaysupport extending from and pivotable relative to the mobile base; and asecond display support extending from and pivotable relative to thefirst display support; wherein the display screen is positioned on thesecond display support.
 6. The robotic surgery system of claim 1,further comprising a fluoroscopic imaging system mounted on the mobilebase.
 7. The robotic surgery system of claim 1, wherein the opticaltracking emitter/detector is movable relative to the mobile base.
 8. Therobotic surgery system of claim 7, comprising an actuator configured toelectromechanically move the optical tracking emitter/detector relativeto the mobile base.
 9. The robotic surgery system of claim 1, furthercomprising an articulating arm, wherein the optical trackingemitter/detector is mounted on the mobile base via the articulating arm.10. The robotic surgery system of claim 1, wherein the circuitrycomprises joint encoders of the robotic device.
 11. The robotic surgerysystem of claim 10, wherein the circuitry is configured to characterizethe pose of the surgical tool relative to the anatomical feature basedon the data from the optical tracking emitter/detector, signals from thejoint encoders, and a geometric relationship between the robotic deviceand the optical tracking emitter/detector.
 12. The robotic surgerysystem of claim 1, further comprising an array coupled to the surgicaltool and configured to be tracked by the optical trackingemitter/detector.
 13. The robotic surgery system of claim 1, wherein thesurgical tool comprises a bone cutting element.
 14. The robotic surgerysystem of claim 1, wherein the circuitry is further configured tocontrol the robotic device to move the surgical tool based on the poseof the surgical tool relative to the anatomical feature.
 15. The roboticsurgery system of claim 1, wherein the circuitry is further configuredto control the robotic device to resist a movement the surgical toolbased on the pose of the surgical tool relative to the anatomicalfeature.
 16. The robotic surgery system of claim 1, wherein thecircuitry is further configured to control the robotic device tomobilize the surgical tool out of the way of the optical trackingemitter/detector to facilitate optical tracking.
 17. A robotic surgeryunit, comprising: a base; a robotic device mounted on the base; anoptical tracking emitter/detector mounted on the base; and a displayscreen mounted on the base.
 18. The robotic surgery unit of claim 17,wherein the base provides a mechanical hub for a plurality ofarticulating arms supporting the robotic device, the optical trackingemitter/detector, and the display screen.
 19. The robotic surgery unitof claim 17, further comprising: a first display support extending fromand pivotable relative to the base; and a second display supportextending from and pivotable relative to a distal end of the firstdisplay support; wherein the display screen is positioned on the seconddisplay support.
 20. A robotic surgery system, comprising: a mobilebase; a robotic arm mounted on the mobile base; a cutting tool mountedon the robotic arm; a trackable marker configured to be coupled to abone; and an optical tracking emitter/detector mounted on the mobilebase, the optical tracking emitter/detector configured to obtain dataindicative of a pose of the bone relative to the cutting tool mounted onthe robotic arm.
 21. The robotic surgery system of claim 20, furthercomprising a control system configured to control the robotic arm toposition the cutting tool relative to the bone using the data from theoptical tracking emitter/detector to facilitate a modification of thebone using the cutting tool.